Psychosis is a topic covered in the 5-Minute Clinical Consult.

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A disorder where thoughts and emotions are significantly impaired (i.e., a loss of contact with reality). Seen in schizophrenia, affective, bipolar, depression, substance use, medical problems, delirium, and dementia; symptoms include the following:

  • Positive symptoms: hallucinations and delusions (fixed false beliefs not typical of cultural background)
  • Negative symptoms: anhedonia, poverty of speech, lack of motivation, social withdrawal, affective blunting
  • Cognition: poor working memory, information processing, difficulty with attention, disorganized speech and/or behavior


  • Schizophrenia: peak onset 18 to 25 years in males; 25 to 35 years in females
  • 1% of the U.S. population; similar percentage worldwide; 1:1 male–female ratio
  • Delusional disorder: 0.3% of population, bipolar: 1–3% of population, unipolar depression: up to 20% prevalence

Etiology and Pathophysiology

  • Stems from many causes, including psychiatric, medical, and/or substance use
  • Positive symptoms relate to excessive dopaminergic activity in the mesolimbic pathway. Negative symptoms relate to diminished dopaminergic activity in mesocortical pathway.
  • Glutamate, steroids, cortisol, inflammation, and developmental abnormalities are likely involved and active areas of research.

Schizophrenia: 50% concordance for monozygotic twins, little or no shared environmental effect; multiple candidate genes involved

Risk Factors

Substance abuse (particularly cannabis or synthetics), family history of psychosis, lower socioeconomic status

General Prevention

Community interventions for early detection and treatment of prodromal symptoms show promise; research currently exploring use of omega-3 fatty acids and anti-inflammatories, which may prevent prodromal progression to schizophrenia

Commonly Associated Conditions

  • Associated with metabolic syndrome, autonomic dysfunction, sudden cardiac death, and cancer mortality: particularly breast and lung cancer
  • Substance abuse disorders, including nicotine dependence

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